Insurance Claims Summary This demo uses an insurance claims example to demonstrate most of the TCM stack, including: Dispatcher auto-classification, human validation of extracted data, TaskSpace, BPI, and BAM. It is not intended to accurately represent a real claims process, but show it can be done and make the demo generic enough for other applications. If you try too hard to make it real and you show it to a real insurance prospect, you make it hard on yourself as they shoot down everything you are showing as unrealistic and the demo becomes too long-winded. Functional Highlights 1. I think the summary covers this – most of the TCM stack is demonstrated. Services That Should Be Started (some of these are started by default) 1. AppServer – Documentum Webapps (should be automatically started) 2. AppServer - Tomcat for BAM and ASR applications. Off by default 3. ContentServer – Content Server/Java Method Server/Docbroker (should be automatically started) 4. ContentServer – You don’t need James Email Server running 5. ContentServer – You don’t need the Index Agent running 6. ContentServer – you may want switch off CTS and Full-text indexing related services. 7. Captiva - InputAccel Server and all related services should be running automatically when the server is started. You can check by looking for it in Services. Installation 1. N/A – Installed on the TCM65_v5 image. Object Locations Most of the object definition is contained in the claims docapp /System/Applications/insurance_claims and don’t need to be opened. The main process Handle Claim is located in the same location. There are also some dummy processes – these are only for visual affect in the demo and don’t do anything. All of the demo data is contained in /Claims Manager cabinet: Claims are where the claims folders will be created, Picklists contains the state/county picklists for the form, Policies contain insurance policies that match up with the policy holders, Policy Holders contain the policy holders that contains the data that will be used in the form later, finally Temp is where Captiva temporarily stores content. All the sample images for this demonstration are located in C:\DEMOS\ABC_Auto_Claims\Images (Captiva Machine) Setup For Demo Run 1. As background, you have 9 potential policy holders with the following SS numbers: 111-11-1111 to 999-99-9999. These policy holders have policy numbers of 0001 to 0009. For example, SS # of 222-22-2222 will have a policy number of 0002. So before the demo, decide which SS # you will fill into the form and then be prepared to make sure that is the matching policy number is used in the Captiva section (whether simulating Captiva or actually running Captiva). 2. AppServer Machine - Open PB and open the /System/Applications/insurance_claims/Handle Claim process. 3. AppServer Machine - Open the Insurance Claims TaskSpace application using the IE favorite (the link is under TCM folder). You can log as dmadmin using the following roles claim_processor, adjuster, customer_service. You can simply switch roles throughout the demo without logging out. 4. Client Machine - If you want to use this demo to focus on Captiva, run the attached script through step 14 so that it is waiting on the repair estimate to come in. That way you can still show a little process because you can show the last task in the demo but you don’t have to show all of the preliminary. For those that want to go light on the Captiva, there is also a way to simulate Captiva (explained in the script). 5. AppServer Machine – You may want to uninstall all of the workflows that aren’t being used in the demo. You should have: Amend Claim, Apply for New Policy, Cancel Policy, Handle Claim, Handle Formal Complaint, Look Up Status of Claim, Look up Status of Policy, Possible Fraud Sub-Process, and Receive Repair Estimate installed. 6. AppServer Machine – You may want to put a shortcut to the Access database described in step 31. 7. Captiva Machine - you can launch the ScanPlus Module, Dispatcher Classification Edit Module, Dispatcher Validation Module. If you need to login, use standard Documentum credentials. Cleanup After Demo 1. You don’t have to do anything to cleanup after the demo. The demo always creates a new case folder with a unique number. Script Step What To Do Business Value or What To Say 1 You are starting out as the customer_service role. This person’s job is to Select Handle Claim and start the process. answer the phone and start some process based on what the customer requests. That is all this person does, so the user- interface only has this tab available. Explain that we will see how the UI changes based on the role of the person. 2 You have a choice of SS #s to fill in from 111111111 Point out the automatic to 999999999 remember this must match the policy claim number generation. number you will or have entered on the repair We can validate the fields estimate that comes later (i.e. 0001 to 0009). that are required and that Purposely leave out the dashes on the SS #. Hit the the data is in the proper Save button (if that doesn’t cause the validation format. The value is that errors to show up, try hitting the submit button next). making sure the data is right the first time saves a lot of potential rework effort. 3 Fix the SS# so that it has dashes now. Hit the tab We can also validate button so that the rest of the fields are filled in. against external systems and automatically pull back info from those systems to reduce effort and make sure the policy holder really exists in the system. This is when the customer service agent can verify who they are speaking to. 4 Fill in the state of the incident (doesn’t matter This shows the dependent which). Drop the county field down and show the picklists because we only available counties. Now choose a different state and show the counties that are pick a county. valid for a particular state. 5 Choose the loss date as a few days ago. Hit the There are many different submit button. types of controls depending on what kind of data is required for a field. 6 It will take a minute for the first manual activity to be Point out what the reached, so open PB to explain the first part of the automated steps are doing process. Here are some things you can do – but you and why that is important. have to decide based on your audience what level of For example, retrieving detail you want. Point out the automated steps that the policy for the user create the claim folder, set some data on it, and means an agent doesn’t retrieve the customer’s policy number. If you want have to go find it in case it to show one activity, I would open the “Create is needed for reference. Claims Folder” to show how it is parameterized. 7 Before minimizing PB, point out our first manual Explain the queue step: Triage Claim. In TaskSpace, change your role management value prop. to claim_processor. Point out the additional tabs but Queue management say we will come back to them later. While on the provides true load My Claims tab, hit Get Next Task. balancing among users because a user doesn’t get the next task until finished with the previous. Queues can help meet SLAs by having different priority escalation depending on what is going on in the process. For example, a platinum customer would have a high priority escalation than a gold customer so the system naturally processes that group of customers faster. 8 Open the task, and point out how the data on the left The story is that this is shown next to an embedded viewer of the policy. person just takes a This data came from various sources but is all shown preliminary look to on one page. Copy the claim number into the double-check basic clipboard for later use in search. information (i.e. is the policy actually active based on the policy dates shown). More investigation will take place later. This is a task specific view and you will see additional examples as we continue the process. The point is to present the exact data needed at this step of the process. The policy was automatically retrieved by the process so that the end user didn’t have to find it. Also, most of the fields are read-only because this person doesn’t have permission to change policy data. Hammer configuration vs customization. 9 Set the Claim Status to Closed – Rejected and then Point out how the reason change it to Awaiting Evidence. (Important: do not field pops-up when it is reject this task). Hit the Finish button. rejected. The value is that any field can be hidden or shown depending on the data in the form so we can guide the user through the task. If you forget to set the status to Awaiting Evidence, don’t worry, it will be automatically set anyway (just don’t leave it as rejected). 10 Now let’s revisit the tabs. Click on Find Claims and The story is that this role search for your claim number that you copied into the can search for all claims clipboard. If you forgot to do that, search for the but customer_service policy number you chose (remember ###-##-#### of could not. You may need the SS maps to 000# policy number). You can show to remind them that we are Browse Claims but I don’t think it is very interesting. trying to show a generic demo and not trying to match reality exactly. The point is role-based UI that was defined with a graphical drag-and-drop tool. 11 Switch role to the adjuster. Again, the UI changes. The adjuster coordinates The adjuster did not use a queue so just open the with the repair shop and task. Set who took the picture(s) and the date it was potentially takes evidence taken. You MUST upload at least one photo (but you photos and/or works with can add more) in the Upload Photos field. Example police reports. So this photos are in D:\Demos\Claims External Content particular task has him/her Just hit the finish button, you don’t need to hit next. uploading photos from a Now hit the Finish button for the task as well. digital camera. I did not use a queue on this step just to point out that we can automatically assign to specific users (remember want to make it a little generic). Explain the value of the digital sign-off. 12 Open PB and explain where we are in the process. We are automatically Optionally, you can open the BAM Dashboard using storing these photos in the the IE favorite and show the running instance (login claim file and setting is admin/admin). After done, close the dashboard so meta-data. Now, the you don’t have to worry about refresh problems process waits for the when you show it later. repair estimate to be faxed in or scanned via Captiva. If you show BAM, explain how alerts and instance maps help a manager know what is going on at take corrective action if necessary. 13 If you want to show a Captiva demo, skip this step Even if you aren’t and go to the next. To simulate Captiva, use DA to showing Captiva, explain import the repair estimate into /Claims the value prop of what we Manager/Temp. The file is located at are simulating. Captiva D:\Demos\Claims External Content\Repair scanned or received off Estimate.pdf. Make the object type repair_estimate the fax server the repair and fill in the appropriate meta-data. The repair shop estimate. It classified and is ABC Auto Repair Shop and make sure the policy OCR’ed data from the number matches the SS# you used to start the demo image so that we have the (i.e. 111-11-1111 matches policy 0001). It takes 5 proper meta-data to seconds or so to get moved out of the Temp folder associate it to the waiting and placed in the proper folder (happens process. This is the exact automatically). same workflow that Captiva starts automatically; in this case, we just started it manually for simulation purposes. 14 Comments In case the question comes up: yes the policy number is not the best to use for a unique identifier to do the matching. It should really be claim number however we wanted to make it easy to demo. If we used claim number, which is automatically generated, we couldn’t prep the Captiva section with the proper claim number ahead of time. Claim number could, absolutely, be the way we match the repair estimate to the claim – any piece of meta- data can be used to do the automatic matching. 15 Switch to the Captiva machine. Find the ScanPlus Level Set – At this point module in the windows toolbar among the running in the big picture, you are applications an employee at a repair shop and you’ve just prepared an estimate to repair the damages. You need to submit them to the Insurance company for review.” “We’re going to scan the documents in this case, but this could just as easily be the repair shop submitting via fax machine, Multi-function device, e-mail, or even a web-browser.” The solution supports virtually any common “capture point” to start this process. 16 Hit New Batch and choose the I’m going to import these ABC_Auto_Claims_v6 process. Click Create. Select documents rather than the Import button from the Scan module scan them since I don’t physically have a scanner attached to this machine, but the functionality is exactly the same. machine, multi-function device… 17 The demo documents should automatically be available when you select the import button, but if they’re not, browse to “C:\DEMOS\ABC_Auto_Claims\Images\Demo.” 18 The images come up in the Scan interface. Click “This is just an arbitrary around between the sample images using your collection of images mouse. When your finished speaking, select “Close designed to demonstrate Batch.” our technology’s ability to automatically identify, separate, and extract relevant data from them. “ 19 “What’s happening behind the scenes right now is the software is busy trying to identify what this document is, find the relevant content on the document and automatically extract it. Whenever the software is not “confident” (based upon thresholds you configure) that it’s identified a page correctly, it delivers the documents to a “human” interface to make sure it’s making the correct assumptions.” 20 Switch to Classification Edit window. If the task is At this point, the software not in the queue yet click refresh list. Once you see has confidently identified the task click “run selected”. Remember the policy the documents in this number should match the SS# you entered earlier so sample set, but it wouldn’t you can manually change it here if necessary. make a very impressive demonstration if it just “showed-up” in the BPM so for purposes of this demo, we simply need to confirm the document type. You also notice that in this case, the software also confirms the Policy number at this stage of the process. 21 While on the Policy Number verification, hit enter. Once the documents are If that doesn’t work, try CTRL-Enter. classified, we move them into our recognition engine to extract the relevant content from the document. For this demonstration, we’re extracting a handful of fields, but this could potentially be dozens of fields that we’re extracting and validating. Including verification of information against a database, field calculations. 22 Switch to Validation interface. Again if the task is Once again, the software not in the list you should click refresh list and then has very confidently “run selected”. You may want to change the amount identified the content to if you are running this several times and want a good extract from this sample of data for BAM. document set. We’ve configured the interface to confirm the data in a human interface. Remember that the overall goal here is to eliminate this human validation altogether. Consider even low confidence scenarios, say 60% failure, we’re still talking about 40% less “human” data entry work than what is being performed, today for example. Those are the kind of raw ROI numbers that can really add-up as your volumes increase. 23 Other options on the page, will allow you to demonstrate Rubber-band OCR. Field level “auto- zoom” and other standard Dispatcher functions. 24 Ctrl – Enter to confirm the data entry elements Once you have validated the data, we move it into the business process and automatically transfer the images and metadata/data/content directly into a specific business process associated with this policy and/or claim number. Remember, finally that what we you just saw is really the exception handling process. The overall goal here is that 100% of these documents never see a human being at all, but rather move directly back into the business process. Considering most paper- based processes in use today, where someone walks to the fax machine sorts these documents and physically moves them around the business to start a physical capture process, we’re talking about a fundamental and very tangible shift in the performance of what was previously a 100% human-based, cumbersome process. Now these documents are already electronic, your knowledge workers can be working from home, via the web, or on the other side of the world to support virtually any business model you can conceive. 25 Switch back to AppServer machine. Open Point out a new UI that TaskSpace as the claims_processor role. Click on was made for this specific My Claims and hit Get Next Task; open the task. role. This role is doing the final review and double-checking the data. Notice that we have the repair estimate associated to the process now as well as the claims folder itself. Note: if the amount did not get filled in correctly, you may have to type it in and hope the question doesn’t come up. Or you can just blow right past it. 26 Open the claims folder by right-clicking on it and Point out that the claims choose open. folder is where some of the data we have seen before is actually stored. Also, the claims folder contains all of the important documents pertinent to this case. 27 Right-click on repair estimate, after explaining, hit We can see the repair the cancel button. estimate next to the data 28 Optionally, right-click on one of the evidence photos We can see the picture and choose open. After explaining, hit cancel. along with the data that was assigned earlier in the process by the adjuster. 29 Close the folder browser by hitting the x on the If you forget to set the thread bar above. Set the status to Closed (don’t set status, don’t worry – I Closed – Rejected). Hit the Finish button to finish automatically set it the task. anyway (just make sure it is not Closed – Rejected). 30 Open PB. Explain that the claim has been closed and Much of the master data one of the things the process does is send the actually resides in external important data to the Claims System. If this is a systems for this process. technical audience, double-click the Write To Claims It is important to be able task and show the data mapping. to use standards-based integration to write and read to/from various systems. In this case, we are just using a simple database because we, of course, don’t have a real claims system; however the concepts are the same regardless of protocol. If you show the data mapper, this should hopefully hit home that we are a real BPM suite and not just a document workflow system. 31 Open Microsoft Access and open the Show that the recent run is Z:\Access\Claims System.accdb database (listed in at the bottom of the table. recent database on the right). You could also prep the system by having a shortcut on the desktop. Double-click the Claims table. 32 Switch to Analysis tab in taskspace. This tab is This tab represent available for claim_processor role. insurance reports. All of them are pretty self- descriptive. Note that you may drilldown into Number of Claims by State report and it will open a dependant report Claims by Policy Type. Please note that these reports are filled with the demo data and do not reflect the changes from your demo process/ 33 Summarize what you have shown and reemphasize the value points you have made along the way.
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